Sunday, February 28, 2010

Most parents have empty-nest syndrome when their kids go off to school, but my separation comes much earlier, like before I even know if they are my kids.

It is a strange feeling to turn your future child over to the hands of a lab for 5 days.

During my first IVF cycle in June/July 2009 my favorite part of the cycle was when my embryos were outside my body. I thought that as long as they weren't with me, I couldn't mess anything up.

But this cycle is much different. I miss my embryos. Maybe it's the hormones that are pulsing through my veins, but I miss them.

Day 2 of the embryos being in the lab (egg retrieval day is counted as day 0), I get my last report before transfer on day 5. The embryologist leaves me a voice message letting me know whether I'll be a day 3 or day 5 transfer. I'll talk more about transfer days later. If we don't have any embryos at the 4-cell stage, I would be scheduled for a day 3 transfer. The lab really wants to see at least a few at the 4-cell stage and all of them need to cleave by then.

Normally, my lab doesn't give the exact number of embryos that are at each stage, but I wanted to know. I've found that if you want something, it's best to ask for it. So, today our report came in and it was very good news. All of the embryos had cleaved, 5 were at the 4-cell stage and all of those were graded very high.

For the next two days, I won't get a report and anything could happen. It's up to the embryo to grow from there and if there's any genetic mishap, they will "arrest" or stop growing. This happens quite frequently, so we need even more division.

Saturday, February 27, 2010

The same day of my egg retrieval a procedure called Intracytoplasmic Sperm Injection is performed. This is commonly know as ICSI (pronounced: ICK-see). The idea is simple and I can only imagine how this procedure came about. Probably two teenagers in labcoats in their parents/ basement were playing around with mice eggs and said, "I wonder what would happen if we took a small needle, put a sperm in it and injected it into an egg [insert teenage giggle]." That's really all the procedure is. Of course you need a REALLY tiny needle and a REALLY powerful microscope.

First, the sperm is washed and the andrologist (sperm-handler) gives the strongest and best sperm the chance to swim up, against gravity. Those sperm are then inspected for quality (ie, not swimming in circles, not having 2 heads, etc) and then one sperm is drawn into the needle. The head of the sperm is closest to the opening of the needle, as it would normally enter the egg, head-first.

The embryologist takes an eggs, holds it with a pipette....all of this is done under a microscope, obviously....takes the needle and pokes through the outer layer of the egg and inserts the sperm inside.

I found a funny video on this. There's lots of these on YouTube, but I chose this one on humor factor alone:

After the egg and sperm meet, it's all up to the embryo whether it will become fertilized. I should mention that ICSI is done on day 0 and fertilization occurs on day 1. If fertilization happens, and we hope that it does, the egg/embryo will look like this:

See the two circles in the middle of the egg? Those are called polar bodies. Still, the cells have not begun to divide, so it looks kind of boring at this point.

Now, to make it a bit more personal. Of my 19 eggs, 16 were ICSI'ed. I'm not sure what rationale is given as to whether or not an egg is ICSI'ed, but I would presume it has to do with maturity of the egg.

The fertilization rate at my clinic is 50%, so I would expect 8 of my eggs to fertilize. Lucky for us, my eggs + G's sperm are already over-achievers, because we have 10 fertilized eggs!

Now we wait till tomorrow when we learn if any of those have begun cell-division. We're wanting 4-cell embryos tomorrow, and lots of them.

Friday, February 26, 2010

Actually, I woke up at 12:30, 3:30, and ultimately 5:00am. Worse than a kid on Christmas morning, I tell you!

Greg, on the other hand slept like a baby.

We left at 6:09, although I wanted to leave at 6:00. I'm always nervous about a wreck or traffic in Nashville and missing my appointment. And, for this, if I miss my appointment, my eggs could ovulate and that would mean my cycle was worthless.

When we got to the office, they weren't even open yet (7:15), so we checked our iPhones for emails and I looked at some of the comments on my blog (thanks!).

I brought something unique to the clinic today. I was worried about hyperstimulating at my appointment yesterday, and asked my IVF nurse, Jennifer about Gatorade since I had read somewhere that it helps. She said, "The nurses in California swear by coconut milk."

Number 1: I HATE coconut with a passion. It's the reason I don't think I could survive on Survivor.

There is no number 2.

I went to the store when I got home yesterday and bought an 8-pack of Gatorade and a can of coconut milk and took it to the office where I was going to open the can and drink it. A few minute after I arrived, Jennifer called with my bloodwork results and I told her I bought coconut milk. She asked where I found it.

me: "Kroger." (duh)

Jennifer: "April, I don't think you can get it at Kroger. What does it look like?"

me: "It's in a can and it's thick, I really don't know how I'll get it down. Maybe I should dilute it."

Jennifer: "DON'T DRINK THAT!!! Bring it to me and I'll use it to cook with."

Basically, my feet go up in stirrups again. The doctor uses a vaginal ultrasound to locate the follicles. Then she guides a needle and small tube up through my abdomen and into each follicle. Then sucks out all the fluid. They may even add extra fluid in and suck it out again, just to make sure they get the egg. The egg is microscopic, but the follicle isn't, so they have to trust that an egg is in there and will come out. After they did that to each one of my follicles, they wheeled me out.

ACK! This procedure isn't pretty, I tell you!

And a little while later, I was awake and snug as a bug under my warm blankets. And a piece of advice to all you ladies out there who stay cold: If you're ever having surgery, the hospital most likely has a blanket warmer. They may or may not tell you about it, but you've already paid for it, so you might as well use it. Heaven on earth!

After I was fully awake, Jennifer came back to talk to us and to wait for the egg count. We waited and waited...and I got more and more nauseous (from the anesthesia).

Jennifer guessed 15 eggs and Greg (forever the optimist) guessed 16.

Finally, Annette, the lab tech came in and told us we had 19!!! Significantly higher than last time.

So, I bounced out of bed and went home, skipping along the way:

um, no.

Once I was cleared to go, I was wheeled out with my saltine crackers and Gatorade and came home to sleep for a bit.

Today, I started the following meds:

Tetracycline (antibiotic) 4 times daily and I'll continue that for 4 days

Medrol (steroid) 1 time a day for the next 4 days

Progesterone in Oil (PIO) via injection once daily until my pregnancy test and with any luck, I'll continue this for a bit longer than that.

Tomorrow is a big day, too. I will receive my fertilization report. Keep your fingers crossed for some polar bodies.

Thursday, February 25, 2010

I got up the nerve to get a photo of the monitor at my visit on Wednesday. This was my last E2 and ultrasound (yay!). I don't know why I felt it was a covert operation because I could have gotten a print out if I had just asked.

At each of my monitoring visits, the ultrasound tech, Patty, looks at my right and left ovaries and measures each follicle one by one. She calls out numbers like 11x15 or 12x13. I write them all down and then I meet with my IVF nurse, Jennifer to discuss it. She adds the two numbers and divides by 2 to get something like 13 and 12.5 for each follicle. When I have several that are at 18 or above, it's time to trigger ovulation. So, tonight, I took two shots of Ovidrel at 9:30pm. That medication induces ovulation exactly 36 hours after injection. So, my egg retrieval is scheduled 35 hours post-injection at 8:30am on Friday. In order to retrieve the eggs, they have to still be in the follicles.

Normal ovulation is very similar to this process. The body develops lots of eggs at the beginning of a cycle (actually, eggs are recruited for development about 3 months out), then somewhere along the way, one surpasses the others and that's the one that is ovulated at about 18mm. I've read that it's rare for an egg less than 15mm to produce a pregnancy. So, whether it's the IVF process developing lots of eggs or the body in a natural process, the egg has to be to a certain level of maturity before pregnancy can occur.

Today, I go back for E2 but not monitoring. And, the best news of all, NO INJECTIONS TOMORROW!!! I get a free day before diving headfirst into progesterone injections later this week.

Considering we have a busy week already, our cows haven't exactly been helping us any. Saturday, #1 had a cow. Then, yesterday about 1:00, Greg ran down the barn steps with binoculars in hand saying, "You need to come look at this! You may never see something like this again!" So up I ran and looked out the front window into the wooded area where #7 (the cow we thought would have a calf first) was standing. Obviously in labor.

Well, that went on and on and on.

Jared, a college kid from church, was helping me with some Studio Calico work, but quickly diverted his attention to helping Greg with the cow. He was in nursing scrubs from his clinical rotation, so he donned my dad's carhart overalls, coat and hat and headed out.

Then, around 5:00 we decided to call the vet and get her up.

If you're not used to farm-speak, you might think "get her up" means to make her stand up, but you'd be wrong. "Get her up" means to get her up in the pen and in the chute, where we can pull a calf if need be.

The vet came at 6:00 but it took awhile to get her up.

So, it was around 8:00 before she was in the chute and he could palpate her. If you don't know what that means, I'm not explaining that one.

She was fully dilated and tired, so they made the decision to pull the calf.

Thankfully, it all worked out, momma and baby are fine and resting in some hay because it's cold tonight.

We'll check on them this morning and hopefully the calf will be on the boob-tube as Jared would say. I plan to take photos, but it was dark last night, so not the best opportunity.

Wednesday, February 24, 2010

There are so many thoughts that go through my head as I'm driving to Nashville for treatments. I've thought about what someone who's never experienced infertility might want to know...putting myself back about 3 years before it was even a thought in my head.

So, here are my confessions as an IVF patient:

I don't want to be asked, "When are you going to have kids?" or any variation of the sort. I'm scared of sounding snotty on this one, but it's hard enough to not think about my fertility 100% of the time. So, when I'm busy and not thinking about it, I don't want to be reminded.

Not all insurances pay for treatment. If you're one of the lucky few whose health insurance covers part of all of your fertility treatment, please be thankful for that. My insurance pays $0. As in "nada", "zilch", "nothing." When I say that, some people look at me like I have 3 eyes. Like I've surely not checked closely enough and that I must be doing something wrong. Nope. I wish I was. It's irksome that insurance will pay for things we choose in some way. For instance, drug rehab. My insurance will pay for stay after stay of drug rehab, costing thousands of dollars, much more than one round of IVF. Every time a druggie consumes a drug, they CHOOSE to do so. I didn't choose infertility. I didn't want to go through this treatment. And, quite frankly, the success rates of IVF are much better than that of rehab. Much cheaper than that of rehab, and I seriously wish it would pay.

There are many genuinely kind people that I am continually astounded by. Shortly after my miscarriage last year, a dear friend of mine (who will remain unnamed because I doubt she wants calls for fertility meds) whose sister is part of a surrogacy group contacted me. She sent me an email, which she thought was so odd. It was an email offering me some meds and supplies left over from her sister's group. She thought for sure I wouldn't take "used" meds, but about 34 seconds after she sent the email, I replied, "YESSSSSSSSSSSSSSSSSSSSSSSSSS send me anything and everything." (Remember insurance confession above.) You see, these meds can cost up to $5000 each round, so I was so grateful when about 1/3 of the medicine I needed showed up on my doorstep. Directly from my bumpfairy.

And, just to make me tear up, this note was attached:There are a lot of mama's in the box. Mama's who have helped other women become mama's, mama's who have helped men become fathers. May the luck of the many women who helped fill this box touch you in your own journey to parenthood. This medication is available for you because it isn't needed anymore, so that's a lot of good luck.

I don't want to be told my hormones are crazy. If you know me, I'm VERY level headed. VERY. Intellectually I know these hormones have an effect, but I don't need to be informed of this every time I say I want Mexican food for dinner and not Japanese. Conform to me people....Conform!!!

Pedicures are a necessary treatment. Some women swear by acupuncture, but I will swear by pedicures. My feet are in the stirrups on a daily basis at this point, so shaved legs and pretty toes are a must. I chose purple polish this round.

I have to make insane decisions while on said hormones (and valium!). Fertile couples don't have to make the decision on how many embryos make it to the uterus. They are blissfully unaware of all the decisions their bodies are making for them. But for me, and so many other IVF patients, we have to struggle between making a decision to transfer more or less. To take the risk of multiples...or the risk of not having any at all. It's a decision that I doubt anyone in my position takes lightly.

Caffeine is a no-no. I'm under orders to have no more than 300mg per day. And, when getting pregnant is as expensive as it is for me, I follow all the rules. Just so you know, this is incredibly tempting since there is a Sonic directly across the street from my clinic.

I'm not sad when others get pregnant. I am genuinely happy when others get pregnant and have healthy babies. I know the pain of infertility. The wondering if I'll ever be a mom. The sadness that comes after a miscarriage. I wouldn't wish this on anyone.

I'm a clock-watcher. I even set an alarm from time to time. I count down the minutes and hours till my next injection.

I pray constantly. I pray for the wisdom to make the right decisions with treatment. I pray with thanksgiving that I have this opportunity (and that our credit card had a large limit). I pray that this round will be successful and that I will one day know the joy of being a mom.

There is a secret society of IVFers. When I meet someone that's been through IVF, we instantly begin talking meds, follicles, and before we know it, an hour has past. Talking follicles is like a secret handshake. Oh, and if you throw in beta numbers, it's even better. Recently, I met someone with whom I have so much in common. We are both scrapbookers. We both think Ali Edwards hung the moon. We both are business owners. But you know what we talked about? Follicles. Yes we did. Then we emailed back and forth about 48 times.

I love my IVF nurse. Her name is Jennifer, but if you request her at my clinic, there's 2 others, so you may or may not get her. I think it's so important for treatment to like your nurse and to build trust with her (or him as the case may be). And, you might even want her husband to make concrete countertops for your house. I did.

I am not supposed to lift over 10 lbs. This is one of the hardest rules to follow. My doctor advises this because my ovaries are super-sized and my tubes could become twisted with too much exertion. Called, "torsion." A laptop bag plus a purse tip the scales. And, if Greg keeps feeding the dogs treats, I might not be able to lift them either.

I have never felt that I'm all alone. I'm blessed with a supportive family. I am blessed with supportive friends and coworkers. I'm also blessed by my blog and SC family. You have shared your stories via email with me as I went through my loss last year. And, even now, I've gained strength from your encouraging words, personal stories and successes.

Last year, I was blessed with one friend in particular. She had gone through IVF and has a healthy baby boy. She checked on me throughout the process and was one of the few that I shared my medical issues with. When I became pregnant, I think she was excited as I was and when we miscarried, I think she was equally saddened. And, when these came a few days later with an encouraging note, it confirmed how much I cherish her friendship. There are so many that are equally as encouraging and who I have connected with through our shared infertility journeys. I can't even put into words what your emails mean to me. Just know that I am incredibly grateful and I save each and every one to read when I'm feeling down. Not that I'm sad all the time. Because I'm not. I'm just being sappy.

Now the update on my progress:

I thought I'd be having my egg retrieval today, but it will most likely be on Friday. After my appointment Monday, my follicles weren't quite ready. And then today, I went back for another monitoring and they were so close, but just not quite there. They need to be 18-20mm before we trigger (more on this later).

Monday, February 22, 2010

Thankfully, I'm about done carrying this case around constantly. But, really, it's not that bad. I consider it my "to-go" pharmacy.

In the left:

Alcohol wipes

Syringe, Q-Cap, and Needle for Menopur

On the right:

Follistim Pen

Follistim Needles

Menopur & Diluent Bottles

Since my shots are at 6:30a and 6:30p, I use this carrier a lot.

I've improved from my last cycle, which was a ziploc baggie.

By the time this posts, I'll be on my way to my (hopefully) last monitoring appointment. Just so you know, it's interesting to KNOW where your ovaries are. Like, really know. I know we've all seen them on diagrams in our health textbooks, but can you feel where your's are? I can.

Sunday, February 21, 2010

I finally feel like we're getting closer to moving in. Things are really starting to look completed instead of just a half-finished job here and there all over the house.

Exhibit A:

Don't look at the unfinished floors in the background and the extra railings piled up.

Actually, the only part of the staircase that's complete is this tiny bit. The rest of the railing at the top of the stairs has to be completed. Hopefully Monday. That would be nice.

I don't think I've mentioned this before, but we had to replace the railing because (1) the original was not my style and (2) the original spindles were spaced wide enough for Lindsey Vonn to ski through like the giant slalom...and in the spirit of having a safe place to raise kids, we thought it best that they be redesigned.

Oh, and they didn't meet building code, so we were forced to replace them anyway.

Exhibit B:

This is to prove why Dave will be claimed on our taxes for both 2009 and 2010 (hi Dave! I know you're reading this!). Last year he spent more time in our home than we did by installing tile in all the bathrooms and kitchen...lots of little tiles that I know he loves.

This year he spent time sealing each one of these tiles by hand. Then arranging them on this entire wall.

He was here till after 7:00 last night and was back again this morning. Some kids...you just can't get them to move out and start a life of their own...they just keep coming back.

Yep, Dave added grout this morning and began plans to come back on Monday for the mud-room.

Friday, February 19, 2010

Like any hobby, IVF comes with lots of equipment. I have a whole cabinet designated for it.

You may have noticed the word "hobby" in my first sentence. Although I don't love this activity, it is like a hobby in that much of my time and thought is devoted to it.

So, let's start with the FSH equipment...

Menopur is an injection I take in the evening. 75 iu and it's quite inconvenient if you ask me. The box that it comes in is large ("cumbersome" as Greg would say....he likes to use dictionary.com's word of the day).

But it has a fun top....am I the only one that likes peeling these things back?

And this is what the inside looks like from the top.

The upper left corner is the Product Insert.The upper right is the Q-capsThe bottom is the Menopur and diluent.

First, the Q-Caps. These fit on the top of the syringe. They work to poke a hole in the top of the little jars so you can draw in the solution.

Next, the product insert. Should I toss this?Why yes I will. All that information is available online, so no use keeping it around.

I will say that the pharma-rep in me does enjoy reading these from time to time....so yes, I read it first before throwing it away. This one reads like a novel. Just look at that first sentence...draws you right in to the story.

Next, the box with the goods....

This is what's inside. On the left, the sodium chloride which is the diluent. On the right, the FSH (Menopur).

Here's a shot of the Sodium Chloride. (duh)

And a little better angle so you can see it just looks like water.

Now, the stuff that makes my eggs grow, grow, GROW.

Yes, that powdery substance is the sweet nectar I crave.

See, it just looks like a pill you could swallow. Which begs the question...how do they get it in that jar? It's smaller than the neck (kind of like those ships in a bottle). Again...inquiring minds want to know.

And, so here is the final line-up for one shot:

Attach Q-Cap to Syringe.

Suck up about 1cc of the Sodium Chloride (diluent).

Push the diluent into the Menopur bottle.

Suck that back up.

Switch out the cap with the needle.

Clean your belly with alcohol swab

Inject (avoid the bruises)

Okay, next line-up is easy. I've already talked about this one.

This is the Lupron that I take every morning for suppression. I draw from the same jar each morning with a little insulin syringe. The needle is attached to this one and there's no fancy Q-Cap to confuse me at the crack of dawn when I'm giving myself this shot.

Leuprolide is the same as Lupron...just so you know I'm not crazy by showing you this photo.

Last, my Follistim, which is FSH (follicle stimulating hormone). I use this in the morning and at night. So, if you're keeping track that's 2 injections in the morning and 2 in the evening for a total of 4 per day.

This is a simple line up as well. I have the pen and the cap that contains the needle.

There's a flap on the top of this that I peel back (kind of like the cap on a creamer but smaller) and that exposes the underside of the needle.

I open my pen and place that onto the pen and twist.

When it's tight, I pull the outer shell off, leaving the needle and the cap on the pen.

Pull off the cap (see this is the tiny needle that Guiliana had a fit about...you can see the size in comparison to my fingers above and below).

I dial the base of the pen to whatever dose I need.

Then, it's time for the injection. That's an easy one, too.

As an update today:

I had my 2nd monitoring today. My uterine lining looks great! It's at 8 and is tri-layer with a streak...that's where the embryo will implant.

My follicles are growing wonderfully. Unlike last cycle, they're all at roughly the same size which is good since they'll all be harvested at the same time.

I got my bloodwork back and my E2 had gone from 469 to over 1100 in a 2-day period. It's not good for it to more-than-double, so I've backed down off my evening dose of FSH. No biggie, just a slight reduction.

I'll go back Monday for another monitoring.

Thank you to the embryologist who cleared up my question about E2. Estradiol is abbreviated E2 because it has 2 OH units (hydroxyl) attached to it. I actually know what this is because my twin sister took 2 semesters of organic chemistry and she babbled about OH a lot! I guess I should have paid more attention. Anyway, thanks for speaking up, I educated my IVF nurse today on the abbreviation, so now she knows, not that she cares. This little tidbit also reminded me that I actually have an embryologist reading my blog who knows waaaaaaaaaaaaaaay more about IVF than I do, so I really need to check my facts before posting.

There was another comment by "bumpfairy" on my last post. I will be talking about her lately. She's near and dear to my heart.

Wednesday, February 17, 2010

Let me start with a disclaimer: These are not my follicles, but they look like mine.

Today was my first monitoring appointment post-stimulation meds. If you remember my earlier post, I've been on follicle stimulating hormones (FSH) since Saturday. The purpose of those is exactly that: make my follicles grow. You might be thinking, "Why would you want all those follicles to grow to be eggs? You can't possibly want 20 kids." But, the fact of the matter is, IVF is a numbers game from the outset. Conception (in general) is a numbers game.

Age: less than 35, you've got a great prognosis Greater than 35, the clock's a-ticking

Number of Follicles: almost 100% related to age, although this can be affected by chemotherapy and other drugs, and genetics.

Number of Eggs Harvested: Of the eggs harvested only about half to 2/3rds will be mature.

Number of Eggs Fertilized: About 1/2 of the mature eggs will become fertilized (possible more if ICSI is used, but more on that later)

Number of Embryos: About 1/2 will make it to transfer.

Number of Implanted Embryos: About 50% chance of implantation.

So, let's do the math. Let's say we have 20 follicles. 12 are harvested as mature eggs. 6 will become fertilized. 3 will make it to transfer (or freezing). 1 or 2 will implant.

I'll talk more on that later, but it's very important that I get lots of follicles and good quality ones at that.

My monitoring appointments are standard. The clinic runs on a very strict schedule, so I never have to wait long. This morning, I checked in at 8:02 and was called for bloodwork at 8:05. Sandy and Mandy are the phlebotomists. Mandy, the UT fan, has a harder time getting my veins, so I always give her my right arm, otherwise, she just fishes around on the left side before ultimately going to the right. So, Mandy drew my blood to check Estradiol levels (called E2 for short).

Because I'm inquisitive in nature, I asked why "estradiol" is abbreviated "E2." The clinic didn't know. So, I came home and researched it online, and couldn't find anything either. Inquiring minds want to know answers to questions like these, so if you know the answer, please speak up!!!

Sorry about that rant.

Here's what I did find out:Estradiol is the most important form of estrogen found in the body. Most of it is made in and released from the ovaries, adrenal cortex, and the placenta, which forms during pregnancy to feed a developing baby.

It's used in IVF to determine how I'm responding to the FSH.

Normal levels are 30-400 pg/mL in a premenopausal woman, not taking FSH.

My level today was 469.

But that's considered well within normal for 5 days of FSH. Trust me, it'll be in the 1000s before I'm done. The reason is the number of follicles. Normal women pick 1 or 2 follicles to grow each month, hence the 30-400 number. For me, I picked about 15 to grow this month. Yes, I told my ovaries which ones to grow.

To be honest, my husband would probably believe it. He thinks I can control my ovaries like I control my appendages. I tell him "autonomic system" but I think he skipped science class.

After my blood was drawn at 8:05, I was told to empty my bladder for the ultrasound. I didn't have to empty my bladder because mine's the size of Texas and it generally fills up only once per day, so I went straight to the ultrasound room.

8:10, Patty the ultrasound tech came in. When I first met Patty, she was a blond. Now, I know Patty quite well. She's a brunette now and I love that her teenage daughter is basically a golf pro. Smartest sport for a teenager to take up if you ask me. Non-contact, play for free through the golf team, and carry the skills with you through retirement.

Patty handed me my clipboard and I knew exactly what to do. Lay down, feet in stirrups, and she started calling out numbers for my right ovary then my left. These were measurements for the follicles. Most of them today were around 10 (mm I think), and they grow about 2mm each day. When they hit 18-20mm it's time for retrieval.

8:20, time to take my ticket to the desk and check-out.

8:30, in the car headed to work.

3:30, my IVF nurse, Jennifer, called with good news. She said my cycle is looking great, even better than my first cycle at this point back in June/July 2009.

One last thing to report: I got my first bruise last night from my injections. First ever. It's not pretty.

Tuesday, February 16, 2010

Normally, I state what's inspired me to create these layouts (or sneaks of layouts), but this month, I was doing good just to get photos and words on paper.

I think what drove me the most this time was the photos. I had taken some photos of Natalee in a pink tutu she had gotten for Christmas. She loved dancing around and singing and performing in pink....so she's actually graced 2 of my layouts and the project so far.